Health inspection·January 13, 2025

F 0688 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Provide appropriate care for a resident to maintain and/or improve range of motion (ROM), limited ROM and/or mobility, unless a decline is for a medical reason. Based on observation, interview, and record review, the facility failed to ensure restorative services were being provided for 3 of 3 residents (R1, R2, R3) reviewed for restoratives and range of motion in a total sample of three. Findings include: The facility's Restorative Nursing Program policy revised on 01/2019 documents, Purpose: to promote each residents ability to maintain or regain the highest degree of independence as safely as possible. Includes, but is not limited to, programs in walking/mobility, dressing and grooming, eating and swallowing, transferring, bed mobility, communication, splint or brace assistance, amputation care and continence programs. Guidelines: Documentation of the interventions and the resident's response will be completed with each implementation. 1. R1's Restorative: Active ROM (Range of Motion) done every shift dated 1/13/25 look back on the last 14 days show the following dates documented as not done. 12/31/24-1/13/25 only done on two shifts instead of three. R1's Restorative: Dressing/grooming done every shift dated 1/13/25 look back on the last 14 days, the following dates not done. 1/3/25: morning, 1/4/25: night, 1/6/25: morning, 1/9/25: evening, and 1/13/25: morning. 2. R2's Restorative Bed Mobility done every shift dated 1/13/25 look back on the last 14 days, the following dates not done. 1/2/25: morning, 1/3/35: morning, 1/5/25: night, 1/6/25: morning, 1/8/25: morning, 1/12/25: morning, and 1/13/25: morning. R2's Restorative: Ambulation: R2 to ambulate with staff 2-3 times per day using with FWW and gait belt x (times) 1 assist with w/c (wheelchair) to follow. 100-200ft (feet), dated 1/13/25 look back on the last 14 days, the following dates not done. Dates 12/31/24-1/13/25 show less than 100-200 feet and not being done on several dates. 3. R3's Restorative: Dressing/grooming, dated 1/13/25 look back on the last 14 days, the following dates not done. 1/2/25: morning, 1/4/25: night, 1/6/25: morning, 1/12/25: morning, and 1/13/25: morning. On 1/13/25 at 9 A.M., V4 (CNA) stated, I do not ever have time to get restoratives done or walking residents. (continued on next page) Any deficiency statement ending with an asterisk (*) denotes a deficiency which the institution may be excused from correcting providing it is determined that other safeguards provide sufficient protection to the patients. (See instructions.) Except for nursing homes, the findings stated above are disclosable 90 days following the date of survey whether or not a plan of correction is provided. For nursing homes, the above findings and plans of correction are disclosable 14 days following the date these documents are made available to the facility. If deficiencies are cited, an approved plan of correction is requisite to continued program participation. LABORATORY DIRECTOR'S OR PROVIDER/SUPPLIER REPRESENTATIVE'S SIGNATURE TITLE (X6) DATE FORM CMS-2567 (02/99) Previous Versions Obsolete Facility ID: If continuation sheet Page 1 of 4 Event ID: 145319 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 145319 B. Wing A. Building (X3) DATE SURVEY COMPLETED 01/13/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Arc at El Paso 555 East Clay El Paso, IL 61738 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)